title: Neighborhood adversity, ethnic diversity, and weak social cohesion and social networks predict high rates of maternal depressive symptoms: a critical realist ecological study in South Western Sydney, Australia.
abstract: The aim of the study reported here is to explore ecological covariate and latent variable associations with perinatal depressive symptoms in South Western Sydney for the purpose of informing subsequent theory generation of perinatal context, depression, and the developmental origins of health and disease. Mothers (n = 15,389) delivering in 2002 and 2003 were assessed at two to three weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were Edinburgh Postnatal Depression Scale (EPDS)> 9 and > 12. Aggregated EPDS > 9 was analyzed for 101 suburbs. Suburb-level variables were drawn from the 2001 Australian Census, New South Wales Crime Statistics, and aggregated individual-level risk factors. Analysis included exploratory factor analysis, univariate and multivariate likelihood, and Bayesian linear regression with conditional autoregressive components. The exploratory factor analysis identified six factors: neighborhood adversity, social cohesion, health behaviors, housing quality, social services, and support networks. Variables associated with neighborhood adversity, social cohesion, social networks, and ethnic diversity were consistently associated with aggregated depressive symptoms. The findings support the theoretical proposition that neighborhood adversity causes maternal psychological distress and depression within the context of social buffers including social networks, social cohesion, and social services.
authors.affiliation: Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool BC, New South Wales 1871, Australia. john.eastwood@sswahs.nsw.gov.au
authors.forename: John Graeme
authors.initials: JG
authors.lastname: Eastwood
authors.forename: Lynn Ann
authors.initials: LA
authors.lastname: Kemp
authors.forename: Bin Badrudin
authors.initials: BB
authors.lastname: Jalaludin
authors.forename: Hai Ngoc
authors.initials: HN
authors.lastname: Phung
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D009517:New South Wales / Q000453:epidemiology; D011632:Public Assistance / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors